PROJECT ABSTRACT Asthma is the most common chronic disease of childhood, and asthma related morbidity costs the US medical system tens of billions of dollars every year. Adherence to asthma medications (specifically inhaled corticosteroids) has been shown to improve asthma related outcomes. Dr. Hoch will evaluate medication usage patterns in depth over one year and develop an intervention with the input of adolescents and providers to improve asthma adherence and control. Dr. Hoch?s overarching hypothesis is that medication adherence trajectory patterns will exist, and that the qualitative analysis will yield actionable ideas for a personalized intervention, aimed at each child?s specific medication use pattern. The purpose of this application is to assist Dr. Hoch in her transition into an independent, federally funded researcher. To this end, Dr. Hoch will use this award to gain additional training in 1) research study methods, including recruitment and retention of subjects and longitudinal data collection, 2) qualitative research methods and 3) the conduct of pragmatic trials in behavior change. She is uniquely positioned within the University of Colorado Anschutz Medical Campus to conduct this work. She will be supported both by the research infrastructure at the University of Colorado School of Medicine and Children?s Hospital Colorado, as well as the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) center. Through these two institutions, she will be guided by a group of internationally recognized researchers, including Dr. Stanley Szefler (Primary mentor and asthma clinical trials expert), Dr. Allison Kempe (health services research mentor and pragmatic trials expert), Dr. Jodi Holtrop (qualitative and mixed methods research expert) and Dr. Angela Bryan (health behavior change expert). In order to accomplish Dr. Hoch?s short term research goals, she proposes a project with the following specific aims: 1) To better characterize adherence trajectory phenotypes, and to combine adherence with short acting beta agonist (SABA) use patterns to create defined asthma treatment phenotypes, 2) Use qualitative methods among adolescents and providers to evaluate reasons for adherence/nonadherence and motivating factors for adherence, feelings about device monitoring and suggested strategies for intervention among each of the highest risk treatment phenotypes using a self-determination theory framework, 3) To develop and pilot test an intervention strategy using the RE-AIM framework, with a focus on the highest priority treatment phenotypes (those with poor adherence/poor control, and those with good adherence/poor control). This approach will yield lessons that will be helpful for the future treatment of asthmatic children by personalizing treatment based on medication use patterns, and train Dr. Hoch for her career as an independent researcher.